Rheumatology Q31

A 75-year-old woman is evaluated for a 2-week history of gradually increasing pain in both shoulders and hips; the pain radiates down both arms to the elbows and down both hamstrings to the knees. She reports no headache, jaw claudication, or vision changes. She was diagnosed with polymyalgia rheumatica 3 months ago. She started prednisone, 15 mg/d, with immediate and complete relief of symptoms; prednisone was weaned from 15 to 10 mg/d 2 months ago, then to 8 mg/d (current dose) 1 month ago. She remained asymptomatic until 2 weeks ago. She says that her current symptoms are just as bad as when she was first diagnosed. On physical examination, vital signs are normal; blood pressure is identical in both arms. There is no temporal tenderness or induration. Painful range of motion of both shoulders and hips is noted.

Which of the following is the most appropriate management?

A Prednisone, 10 mg/d

B Prednisone, 30 mg/d

C Prednisone, 60 mg/d

D Prednisone, 20 mg/d, and methotrexate

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